Healthcare is an important part of our budgets and health costs are once again rising, says Madelein Bester, Benefit Management Manager at Mediscor PBM. With more than 1.6 million South Africans currently benefiting from the Pharmacy Benefit Management (PBM) services offered by Mediscor, the company is well placed to track and analyse medicine expenses.
“Increases in expenditure on medicines had slowed down quite considerably in previous years - for example, the increase for 2006 over 2005 was only 5.4% - but now it's shot up into double digits, at 13.3% for 2007 when compared to 2006,” she explains. “To keep health care affordable, we all need to give some thought to why these costs are rising - and what we can do about it,” comments Madelein Bester.
* Some of the increase can be attributed to inflation (manufacturers were allowed to increase their Single Exit Price (SEP) in January last year, for example, which naturally bumped up prices).
* Some can be attributed to a change in the mix of medicines being claimed for: doctors are prescribing more expensive medicines. These are often novel therapies that have recently become available (HerceptinTM, the new treatment for breast cancer, springs to mind here, as does CipralexTM, a new anti-depressant which has been heavily prescribed recently). Medicines are subject to fashion, like other products: a medicine may become a ‘blockbuster' because it's new and in fashion, rather than because it has genuinely additional therapeutic advantages! Of course, new products take a while before they move out of patent, which means there are no generics available, and they are expensive as manufacturers recoup the research and development costs.
* Some of this is because of an increase in claims for anti-viral products (including anti-retroviral agents), following the introduction of these as part of the Prescribed Minimum Benefit package for HIV/AIDS, which took place in 2005.
“While many factors influencing price are beyond our control, as patients or prescribing doctors, there are a couple of ways in which we can all help to reduce medicine inflation,” explains Dr Hammann, Head: Medical Affairs at Mediscor.
“One way can be summed up in a single word: compliance. Every time a patient does not ‘finish the course' of antibiotics, for instance, they open themselves up to a potential recurrence of the infection - and a potentially more virulent one at that. The doctor will have to prescribe a further course of antibiotics, and possibly a more expensive one that is capable of killing the more resistant organisms that results. This disastrous habit has, in one example, left us a truly awful legacy - Multi Drug Resistant Tuberculosis (MDRTB) - which is harder and much more expensive to treat.”
Non-compliance has a similar effect with other types of condition, too. The person who does not comply with a diabetic medicine regime is creating trouble for themselves - and costs for their medical scheme. This is because sooner or later, there will be health consequences like kidney complications, for instance, which require not only more, but more expensive medicines.
Non-compliance to prescribed drug regimes is dangerous for the patient, exposing them both to more illnesses and to potentially more medicines, with the potential for side effects like loss of libido, which can affect quality of life. It is also dangerous for public health: as in the TB example, an individual's infection can become a country's epidemic if it is not managed properly at the outset.
“Compliant patients safeguard their own health and that of their fellow citizens; they also save themselves money. The medical schemes they belong to save money, too, and therefore are able to use their funds more effectively, and avoid big premium increases,” asserts Dr Hammann.
Another way that doctors and patients can help to reduce medicines inflation is by not succumbing to fashion and trends. If there is an existing product that does the job effectively, why reach for a new product, still under patent and very expensive? If half the country seems to be taking a certain anti-depressant or therapeutic agent for osteoporosis that does not mean it will be effective for every patient who asks for it.
“Just as with every other aspect of our lives, we need to be discriminating and responsible consumers, of both medicines and information about medicines,” says Dr Hammann. “In fact, it's more important to be careful and savvy in this regard. Non-compliance is not just a waste of money, like when you take out a contract at the gym and use it only a couple of times in the year. It can also represent a very real, physical danger to you and your family. Demanding medicines that may not be 100% suitable for your condition is unwise for the same reason. Instead, talk to your doctor about what will really be effective for you, and ask him or her to put together a medicine ‘package' which will work but will cost the least possible amount of money.”
